National Provider Identifier [NPI]: |
1073558409 |
Last Name Of The Provider |
KOLADE |
First Name Of The Provider |
VICTOR |
Middle Initial Of The Provider |
O |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
960 E 3RD ST |
Street Address 2 Of The Provider |
#200 |
City Of The Provider |
CHATTANOOGA |
Zip Code Of The Provider |
374032104 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
556 |
Number Of Medicare Beneficiaries |
218 |
Total Submitted Charge Amount |
68347.5 |
Total Medicare Allowed Amount |
31584.93 |
Total Medicare Payment Amount |
22241.96 |
Total Medicare Standardized Payment Amount |
23934.43 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
15 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
496.5 |
Total Drug Medicare AllowedAmount |
240.35 |
Total Drug Medicare PaymentAmount |
234.08 |
Total Drug Medicare Standardized Payment Amount |
234.08 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
29 |
Number Of Medical Services |
541 |
Number Of Medicare Beneficiaries With Medical Services |
218 |
Total Medical Submitted Charge Amount |
67851 |
Total Medical Medicare Allowed Amount |
31344.58 |
Total Medical Medicare Payment Amount |
22007.88 |
Total Medical Medicare Standardized Payment Amount |
23700.35 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
81 |
Number Of Beneficiaries Age 65 to 74 |
78 |
Number Of Beneficiaries Age 75 to 84 |
41 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
121 |
Number Of Male Beneficiaries |
97 |
Number Of Non Hispanic White Beneficiaries |
145 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
119 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
99 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.4484 |